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Published on: August 7, 2018
Lumbar microdiscectomy: a clinicoradiological analysis of outcome
Ralph Rahme1, Ronald Moussa, Rabih Bou-Nassif
1Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
Background:
The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome.
Methods:
All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up.
Results:
Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome.
Conclusion:
Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.
Insights
Lumbar microdiscectomy outcomes are generally good, though some patients experience persistent low back pain. Female sex, young age, lack of exercise, and chronic preoperative pain predict poorer results after surgery.
Area of Science:
- Neurosurgery
- Orthopedics
- Spinal Surgery
Background:
- Long-term outcomes after lumbar microdiscectomy (LMD) can be influenced by low back pain (LBP) and segmental instability.
- The specific factors affecting LMD outcomes remain unclear, necessitating further investigation.
Purpose of the Study:
- To analyze the interplay of clinical, functional, and radiological variables impacting patient outcomes post-LMD.
- To identify predictors of long-term success or failure following lumbar microdiscectomy.
Main Methods:
- Retrospective cohort study of patients undergoing LMD between 2004-2005.
- Clinical and radiological re-evaluation conducted at a 3-5 year follow-up.
- Multivariate logistic regression used to identify prognostic factors.
Main Results:
- Forty-one patients completed follow-up; 29.3% reported moderate-to-severe sciatica and 31.7% showed segmental instability.
- Most patients (92.7%) had minimal disability, and 80.5% returned to full-time work.
- Negative prognostic factors included female sex, young age, lack of exercise, and chronic preoperative LBP. Disc collapse was common, especially at L4-L5, but did not correlate with outcomes.
Conclusions:
- Significant disability and dissatisfaction are uncommon after LMD, despite residual symptoms in some patients.
- Predictors of worse outcomes include female sex, young age, sedentary lifestyle, and chronic preoperative low back pain.
- Disc collapse and Modic changes were prevalent but did not significantly impact patient outcomes.